c u S e pl Sim s s

c u S e pl Sim s s ce Lung Cancer for Finals Tim Robbins Academic FY 1 UHCW Syp RF Signs Comp Inx Histology Rx Surg

Ron Ailman: Symptoms • • Cough Haempotysis Dyspnoea Chest Pain Recurrent pneumonia Anorexia/weight loss Hoarseness of voice Patient photo/data from: http: //www. macmillan. org. uk Syp RF Signs Comp Inx Histology Rx Surg

Risk Factors • Cigarette Smoking • Industrial contaminants: Asbestos/arsenic • Radon gas • Genetic pre-disposition Syp RF Signs Comp Inx Histology Rx Surg

Signs Syp RF Signs Comp Inx Histology Rx Surg

Chest Signs Pleural Effusion: -Decreased chest wall movement -Stony dullness -Decreased breath sounds -Decreased vocal fremitus -Pleural Rub (above) -Mediastinal shift away Atelectasis: -Decreased chest wall movement - Dullness to percussion - Decreased breath sounds - Decreased vocal resonance - Mediastinal shift towards Consolidation: - Crackles - Decreased chest wall movement - Dullness to percussion - Bronchial breathing / increased breath sounds - Increased vocal resonance Syp RF Signs Comp Inx Histology Rx Surg

Complications Local Syp Metastases Endocrine • Recurrent Laryngeal nerve palsy • Horner's Syndrome (Pancoast’s tumour) • Rib erosion • Brain, bone, liver, adrenals • SIADH • Excess ACTH secretion • Addisons Syndrome • Gynaecomastia Neurological • Lambert Eaton Syndrome • Proximal Myopathy Cardiovascular • Pericarditis • SVC obstruction • Venous Thomboembolism RF Signs Comp Inx Histology Rx Surg

Investigations CT Chest X-ray Radio-nucleotide uptake scan Diagnosis Syp Stage RF Sputum Pleural fluid LN aspiration Bronchoscopy Signs Comp Grade Inx Histology Rx Surg

Histology Non-Small Cell Adenocarcinoma Squamous cell Large-cell Neurosecretory cells 50% 2 year survival if caught before spread 3 month median survival if untreated 1/1. 5 yrs with Rx Staging: TNM Syp RF Signs Comp Inx Histology Rx Surg

Treatment Small Cell Non-Small Cell • Excision if no metastatic spread • Almost inevitably disseminated • Curative radiotherapy if respiratory reserve poor • Chemotherapy, but relapse • Radiotherapy for symptomatic relief: • Chemotherapy +/- radiotherapy in advanced disease (likely palliative) Bronchial Obstruction SVC obstruction Haemoptysis • SVC stenting / endobronchial therapy Syp RF Signs Comp Inx Histology Rx Surg

Surgery – the curve ball OSCE Lobectomy / pneumonectomy with LN excision The similarities: Both have thoracotomy scars. Both have reduced chest expansion and reduced AE. The differences: 1. The signs of lobectomy are confined to lobe which is removed. 2. The signs of pneumonectomy are extensive i. e. involve the whole lung. The side involved would be flatten. It is similar to whole lung collapse. 3. Normally, the tracheal is central in lobectomy (except for upper lobe). The tracheal is almost always shifted in pneumonectomy. Syp RF Signs Comp Inx Histology Rx Surg